Peripheral Atheromatous Arterial Disease in the Young: Risk Factors, Clinical Features, and Prognosis From the COPART Cohort

Abstract

We describe the cardiovascular risk factors, clinical presentation, and prognosis in a comparative study of patients with peripheral artery disease (PAD) from the Cohorte des Patients ARTériopathes (COPART) cohort, which includes patients hospitalized for PAD in France. Among the 2514 patients included in the cohort, 189 had PAD before or at the age of 50 years and 2325 had it after. Young patients with PAD had diabetes less frequently (34% vs 46%, P < .001), were more frequent active smokers (58% vs 23%, P < 0.001), had lower high-density lipoprotein cholesterol (HDL-C; 41 ± 14 vs 44 ± 15 mg/dL, P = .026), and had a less frequent family and personal history of coronary heart disease. In a subset of 59 patients whose lipoprotein (a) (Lp(a)) was measured, the Lp(a) levels were higher in the young patients than in the older ones (89.7 mg/dL [9.7-151.3] vs 19.9 mg/dL [3.0-207.9], P = .004). Survival and amputation-free survival was 2.2 times higher (1.5-3.2, P < .001) in the young after 1 year. The onset of PAD before 50 years was associated with active smoking, low HDL-C, high Lp(a), and lower mortality.

Barriers and enablers to walking in individuals with intermittent claudication: A systematic review to conceptualize a relevant and patient-centered program

“…Although age is a significant risk factor in PAD, young adults are increasingly affected[ 26 , 27 ]. Moreover, age-mediated variations in the clinical symptomology of PAD suggest that claudication is more prevalent in the younger patients (≤50years)[ 28 ]. The aim of this review is to systematically review the literature regarding both self-report and objective measures of barriers and enablers to walking exercise in individuals with IC.…”

Under-Prescription of Medical Treatment for Peripheral Artery Disease in the Under 50s: A Retrospective Study

“…1 CVRFs were frequently uncontrolled, without use of statins or antihypertensives. 6 Tobacco consumption was acknowledged by a large majority of patients in our series (93%), despite the decrease of tobacco use in the 90s in France and other European countries. 8 Active smoking is widely recognized as a major contributor to the onset and to worse outcomes in PAD.…”

“…During follow-up the major amputation rate was 12.6%, lower than the amputation rate previously reported in older patients (>20%). 6,26 In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial, major amputation was significantly associated with acute limb ischemia at diagnosis, demonstrating the worsened outcomes associated with a severe initial presentation. 27 This study has several limitations.…”

“…5 The Cohorte des Patients ARTeriopathes (COPART) study reported that in cases with an atherosclerosis etiology, specific risk factors should be investigated, particularly genetic predisposition to an abnormal lipid profile. 6 To date, data on outcomes and follow-up are lacking in this specific setting.…”

Lipoprotein(a) and Cardiovascular Disease: A Missing Link for Premature Atherosclerotic Heart Disease and/or Residual Risk

“…89 Interestingly, in a subgroup of 59 of 189 patients who had PAD at the age of #50 years, with Lp(a) measurements, the Lp(a) levels were higher in the young versus the older patients (89.7 vs. 19.9 mg/dL, P = 0.004). 90 As mentioned, an imaging study showed that persons with high Lp(a) (108 mg/dL; n = 30) have higher degree of arterial inflammation and increased peripheral blood mononuclear cells trafficking to the arterial wall compared with persons with normal Lp(a) (7 mg/dL; n = 30). 24…”